Abstract 11837: Quantitative Relation of Serum Eicosapentaenoic Acid/ Arachidonic Acid Ratio to Arrhythmic Events

Abstract

Background It is well known that a low ratio of serum eicosapentaenoic acid (EPA) to arachidonic acid (AA) is closely related to cardiovascular events. Other studies report that intake of fish oil is associated with reduction of occurrence of atrial fibrillation (AF) and lethal ventricular arrhythmia (VA), and prevents sudden cardiac death. We aimed to investigate the quantitative relationship between EPA/AA and each arrhythmia.

Methods and results The EPA/AA ratio was measured in total consecutive 504 patients with arrhythmia (atrial tachyarrhythmia (n=400), ventricular tachyarrhythmia (n=79),), bradyarrhythmia (n=25) and in 67 age-matched control subjects without arrhythmia. EPA/AA ratio in 48 patients with lethal VA (ventricular tachycardia (VT) and ventricular fibrillation (VF)) (0.29±0.14) was lower than those with other arrhythmia (paroxysmal supraventricular tachycardia (PSVT) 0.48±0.57, paroxysmal atrial fibrillation (PAF) 0.48±0.31, chronic atrial fibrillation (CAF) 0.43±0.27, premature ventricular contraction (PVC) 0.37±0.23, bradyarrythmia 0.46±0.24, P<0.05) and control subjects (0.45.±0.27, p<0.01). However, general risk factors of cardiovascular disease (sex, hypertension, BNP, HbA1c, LDL-C and HDL-C) were not significantly different between patients with lethal VA and others. Additionally, the mean EPA/AA ratio (0.28±0.15) of 22 patients with non-ischemic VF, who were low-risk of ischemic event, was the lowest among arrhythmia subgroups. Among arrhythmias groups other than VA, the EPA/AA ratio was not significantly different. We analyzed the impact of age on EPA/AA ratio in each arrhythmia group. Among 197 patients with PAF, younger adults (<50 years) who have little risk factors of cardiovascular event showed significantly lower EPA/AA ratio than that of older adults (0.30±0.18 vs. 0.49±0.31, p<0.01). Such an age-related difference in the EPA/AA ratio was not found in CAF group.

Conclusion Lethal VA is associated with the lowest EPA/AA ratio, and a low EPA/AA ratio shows close relation to non-ischemic VF. Among patients with AF, the low EPA/AA ratio is also associated with PAF of patients of < 50 years old. Increase in EPA/AA ratio by EPA might be another therapeutic goal to treat lethal VA and PAF of young patients.